Microdissection testicular sperm extraction (micro-TESE) is a specialised surgical technique used to look for sperm directly within the testicles when no sperm are found in the ejaculate. It is most often considered for men with non-obstructive azoospermia, where sperm production is very low or patchy rather than blocked. When sperm are successfully retrieved, they can be used with IVF and intracytoplasmic sperm injection (ICSI), where a single sperm is injected into an egg.

Understanding what micro-TESE is designed to do

Micro-TESE is a form of testicular sperm retrieval performed using an operating microscope. The microscope allows the surgeon to identify and selectively sample the most promising seminiferous tubules (the tiny structures where sperm are made). This targeted approach aims to maximise the chance of finding sperm while minimising the amount of testicular tissue removed.

Micro-TESE does not treat the underlying cause of azoospermia. Instead, it is a method of retrieving sperm for use in assisted reproduction.

When micro-TESE may be appropriate

Micro-TESE is most commonly recommended when:

• Semen analysis (usually repeated) shows azoospermia (no sperm in the ejaculate)
• Investigations suggest non-obstructive azoospermia, meaning sperm production is severely reduced
• Other options are unlikely to retrieve sperm from the ejaculate

It may also be considered in selected situations where sperm are present in the semen but outcomes with IVF have been repeatedly poor, and the fertility team suspects that surgically retrieved sperm may be a better option for ICSI. This is not suitable for everyone and needs careful individual assessment.

Situations where micro-TESE may not be suitable

Micro-TESE is not appropriate in every case of male infertility. It may be unlikely to help, or not recommended, when:

• Genetic testing shows certain Y-chromosome microdeletions (particularly AZFa or AZFb deletions, or combined deletions affecting these regions), where sperm production is typically absent
• Azoospermia is clearly obstructive and a different approach is more appropriate, such as surgical reconstruction or simpler sperm retrieval methods
• There are medical reasons that make surgery or general anaesthesia unsafe without optimisation

Because the decision is highly individual, suitability is confirmed after a full male fertility assessment.

Assessment and planning before surgery

A careful pre-operative work-up is essential, both to confirm the diagnosis and to plan the best route to pregnancy.

At your consultation, assessment typically includes:

• Review of prior semen analyses and fertility history
• Physical examination
• Hormone testing (such as FSH, LH, testosterone, prolactin)
• Scrotal ultrasound when indicated
• Genetic testing where appropriate (commonly karyotype and Y-chromosome microdeletion testing)
• Review of current medications and medical conditions

Micro-TESE is usually planned in coordination with the female partner’s IVF cycle. Timing can be arranged so that sperm retrieval is performed close to egg collection, or sperm can be frozen for later use depending on the clinical plan and laboratory considerations.

How the procedure is generally carried out

Micro-TESE is performed in an operating theatre under sterile conditions, most often under general anaesthesia.

In broad terms:

• A small incision is made in the scrotal skin
• The testicle is carefully opened to expose the tissue
• An operating microscope is used to examine the tubules at high magnification
• Small samples are taken from areas that look most likely to contain sperm
• The samples are immediately processed by the embryology laboratory to search for sperm

If sperm are found, they may be:

• Used fresh for ICSI (depending on timing with egg collection)
• Frozen (cryopreserved) for future IVF/ICSI cycles

Procedure time varies depending on complexity and findings, but it commonly takes around 1 to 2 hours. Most patients go home the same day after a period of recovery monitoring.

What recovery is usually like

Recovery after micro-TESE is typically manageable, but it is still surgery and some discomfort is expected.

Common early experiences include:

• Mild to moderate scrotal pain or aching
• Swelling and bruising
• A feeling of heaviness in the scrotum

General aftercare guidance often includes:

• Rest for the first 24 to 48 hours and gradual return to normal activity
• Supportive underwear to reduce movement and discomfort
• Simple pain relief as advised
• Keeping the area clean and dry, following wound-care instructions
• Avoiding heavy lifting, strenuous exercise, and sexual activity for a short period (often around 1 to 2 weeks, depending on healing)

Stitches are commonly dissolvable. A follow-up appointment is usually arranged to check healing, review results, and discuss next steps with the fertility team.

Results and what to expect

The key outcome is whether sperm can be retrieved. In non-obstructive azoospermia, sperm production can be patchy, so retrieval is not guaranteed even with micro-TESE.

If sperm are found, the next step is typically IVF with ICSI. Pregnancy outcomes then depend on multiple factors, including:

• The number and quality of sperm retrieved
• Egg quality and ovarian response
• Embryo development
• Female partner’s age and reproductive health

Your team will explain what was found during the procedure, whether sperm were frozen, and how this affects the IVF plan.

Risks, limitations, and important considerations

Micro-TESE is generally considered safe when performed by an experienced team, but all surgery carries risk.

Potential risks include:

• Bleeding or haematoma (a collection of blood in the scrotum)
• Infection
• Pain that lasts longer than expected
• Scarring or changes within the testicular tissue

Because tissue is taken from the testicle, there is also a small risk of temporary reduction in testosterone levels. In many men, testosterone recovers over the following weeks, but monitoring may be advised, especially if there are symptoms such as fatigue, low mood, or reduced libido.

Important limitations to understand:

• Sperm retrieval is not guaranteed, particularly in severe non-obstructive azoospermia
• Even when sperm are retrieved, IVF/ICSI may not lead to pregnancy
• Genetic causes of azoospermia can affect both the chance of retrieval and potential implications for offspring, so genetic counselling may be recommended

Your consultation and ongoing support

Micro-TESE is not a standalone procedure. It is part of a coordinated fertility pathway that includes diagnosis, surgical planning, embryology support, and IVF decision-making.

At our clinic, care is structured so you have clear continuity from assessment through to follow-up. Your urology and fertility team will:

• Confirm the cause of azoospermia and explain realistic chances of sperm retrieval
• Review genetic and hormonal findings and what they mean for treatment
• Coordinate timing with the IVF laboratory and, where relevant, the female partner’s treatment plan
• Provide clear guidance on preparation, recovery, and when to seek advice after surgery

If micro-TESE is recommended, you will be supported with a personalised plan that prioritises safety, careful tissue handling, and close collaboration with the embryology team to give the best possible chance of finding usable sperm.